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At the Health IT Summit in Boston, a Fresh Look at the Emergence of Personalized Medicine – Healthcare Informatics
Posted: June 24, 2017 at 1:48 pm
How might the shift towards personalized medicine and towards precision medicinetwo related but different conceptsimpact cancer care within the United States healthcare system? That question was explored in some depth during a presentation entitled, Using Precision Medicine and Personalized Medicine to Build a Patient-Centered Strategy, the first presentation given on June 15, during the Health IT Summit in Boston, held at Bostons Revere Hotel, and sponsored by Healthcare Informatics. The presentation was given by Kristin Darby, CIO at the Boca Raton, Fla.-based Cancer Treatment Centers of America, and John Halamka, M.D., CIO at Beth Israel Deaconess Medical Center in Boston.
After explaining in some detail the broad treatment philosophy and strategy at Cancer Treatment Centers of America, Darby noted that There are a lot of paradigm shifts going on as we start to change our industry, and some of the themes involved in oncology are similar to those emerging across U.S. healthcare as a whole. Among them, she said, are the move from predictive to reactive care, from sick care to wellness, and moving towards care thats specific to a patient. And when you look at precision medicine, there are specifics that can be determined about the classification of disease at the molecular level, rather than organ or body location.
What about the two terms? Personalized medicine and precision medicine are terms that are often used interchangeably, Darby said. But there is a difference, she pointed out. Precision medicine focuses on the specific needs of a patient and their known response to specific biomarkers. Patients typically go through genomic testing, and the results are tested based on known biomarkers, and their treatment is then adjusted. Meanwhile, personalized medicine can include precision medicine as one of its components, but also includes such things as lifestyle, patient preferences, and the patients lifestyle.
Darby went on to say that, As you start to look at the value of precision medicinehistorically, prior to this, the approach has been population-based, with the same approach for everyone, and only a certain percentage of those approaches working. And when it comes to oncology, those approaches kill healthy genes as well as diseased genes. But with personalized medicine, you take into account elements important to the patient. And it also includes looking at lifestyle and other factors that can really help the patient individually. She said that a famous quote from science fiction writer Isaac Asimov applies here: One of the saddest things in life, he said, is that science gains knowledge much faster than society gains wisdom, she said. And you can see that with precision medicine: advances are happening at such a rapid rate that individuals cannot absorb the new knowledge.
Kristin Darby and John Halamka, M.D. on June 15
Darby continued, Thats where technology comes in, to help individual patients. And typically, most healthcare providers are doing partial genome sequencing, which might include a 300-gene panel, followed by targeted therapies for specific abnormalities. What youll see sometime in the near future, she said, is an evolution of maturity where, when the test is done, the goal is to move that to time of diagnosis. And we believe at Cancer Treatment Centers of America that well continue to move closer to diagnosis in order to avert going through failed rounds of care. Often, she said, patients dont pursue genomic testing until after two or three rounds of treatment have already failed; meanwhile, overall health tends to decline with each round of chemotherapy. In contrast, she said, in the future, a personalized approach to treatment will be available. And it will mature from partial genome sequencing to full genome sequencing, which will look at healthy DNA. And instead of just looking at DNA, from a targeted therapy perspective, the abnormality causing the disease may only affect the patient as its expressed. And with proteomics, physicians will be able to offer more specific, targeted treatment.
Darby went on to share with the audience a case study that had been approved for public sharing, by the patient involved. The patient is Christine Bray, who was diagnosed at the age of 30 with metastatic ovarian cancer in 2010, when her youngest daughter was just three months old. Bray was given five months to live. Her goal was to survive at least a few years, so that her youngest daughter would have a memory of her. She went through a horrendous experience, with numerous treatments and surgeries, Darby said of Bray. Then she came to CTCA in Philadelphia, and received advanced genomic testing, which identified a therapy that would target the tumors genetic mutation (everolimus). It was when she got her third diagnosis of recurrence that she came to CTCA. And it was identified that she would benefit from genetic testing, and received targeted therapy. Within three months, she was cancer-free and has lived a normal life for five years now, with no evidence of disease. That shows the promise of precision medicine.
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At the Health IT Summit in Boston, a Fresh Look at the Emergence of Personalized Medicine - Healthcare Informatics
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Bluebird Reports Early Results From Upgraded Gene Therapy – Xconomy
Posted: at 1:48 pm
Xconomy Boston
One of the years most closely watched clinical studies could lead to a landmark approval of a gene therapy and throw wide open the debate over how to pay for expensive drugs. The first drips of data have emerged.
Bluebird Bio (NASDAQ: BLUE) says the first three patientsof 15 total expectedhave had good results from a revised version of its LentiGlobin gene therapy to treat certain genetic variants of the rare blood disease beta-thalassemia, which causes severe anemia and requires frequent transfusions.
Bluebird has changed the way it manufactures the product, which requires extracting a patients bone marrow cells, altering their DNA outside the body, then reintroducing the cells to the patient. This study, called NORTHSTAR-2, is the first test of the improved process, which regulators said last year would not require rewinding its clinical program back to the beginninga sigh of relief at the time for the company and its shareholders.
Caveats abound. The results are not only a small sample size, they are also early. Typically data from three patients in a study would not be worth singling out. But Bluebird, of Cambridge, MA, is trying to produce a type of medicine never approved before in the U.S. (Two have been approved in Europe, but one never took hold.)
And the FDA has already shown willingness to consider approval of medicines for rare diseases based on tiny sample sizeswith considerable controversy, in the case of a drug approved last year to treat Duchenne muscular dystrophy.
In one NORTHSTAR-2 patient, the healthy version of the blood protein hemoglobin has reached normal levels six months after a single dose of treatment. The second patients healthy hemoglobin levels are rising but lower than the first patient after three months. The third patient is only two months out from treatment.
For patients with good results, the treatments staying power will be crucial. Bluebird wants it to be a one-time cure, as of course will patients. Insurers will undoubtedly want the samebut what to do if something that costs hundreds of thousands or more than a million dollars, stops working after a few years?
Bluebird officials say they have already begun talking to payers about pay for performance arrangements. Our hope is to tie outcomes of the patient to the value generated, says chief financial and strategic officer Jeff Walsh. It can come in many different forms. (Xconomy reported on several creative drug-pricing ideas in this article.)
Bluebird hopes to make a case for approval for beta-thalassemia before U.S. and European regulators, perhaps in 2019, using data from the NORTHSTAR-2 trial and from previous trials that used the older LentiGlobin version. The main goal of NORTHSTAR-2 is for patients to produce enough of their own healthy hemoglobin to eliminate the need for regular blood transfusions. The first patient has reached that goal, says chief medical officer David Davidson.
The new version of LentiGlobin product, among other things, squeezes more copies of the correct gene into each targeted cellmore shots on goal to change each malfunctioning cell for the better, in other words.
The NORTHSTAR-2 patient with six months of results to report has fared better than similar beta-thalassemia patients six months after they received the previous version of LentiGlobin in a study called HGB-204. The NORTHSTAR-2 patient is producing 13.3 g/DL of hemoglobin, within the normal range for a woman; the median production among 10 HGB-204 patients after six months was 9.7 g/DL.
A doctor working on the study is presenting the data, along with updates from its LentiGlobin treatment for sickle cell disease, at the European Hematology Association meeting this weekend.
Alex Lash is Xconomy's National Biotech Editor. He is based in San Francisco.
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Germany wants to fine Facebook over hate speech, raising fears of … – The Verge
Posted: at 1:47 pm
Facebook, Twitter, and other web companies are facing increased pressure to remove hate speech, fake news, and other content in Europe, where lawmakers are considering new measures that critics say could infringe on freedom of speech.
In the wake of recent terrorist attacks in Britain, Prime Minister Theresa May and French President Emmanuel Macron said last week they are considering imposing fines on social media companies that fail to take action against terrorist propaganda and other violent content. The European Union, meanwhile, recently moved closer to passing regulations that would require social media companies to block any videos containing hate speech or incitements to terrorism.
But nowhere is the pressure more acute than in Germany, where lawmakers are racing to pass new legislation that would impose fines of up to 50 million ($55.8 million) on tech companies that fail to remove hate speech, incitements to violence, and other obviously illegal content from their platforms. Companies would have to remove clearly illegal content within 24 hours; they would have up to one week to decide on cases that are less clear.
The Social Networks Enforcement Law, first announced in March by Justice Minister Heiko Maas, aims to hold social media companies more accountable for the content published on their sites, and to ensure they are in accordance with Germanys strict laws on hate speech and defamation. But the bill has drawn vehement criticism from rights groups, lawyers, and a diverse mix of politicians, who say such steep financial penalties could incentivize tech companies to censor legal speech out of caution. Critics also claim that the proposed legislation known as the Facebook Law would give social media companies undue power to determine what people can say online, effectively outsourcing decisions that should be taken by the justice system.
a wholesale privatization of freedom of expression
Joe McNamee, executive director of the Brussels-based digital rights group EDRi, says the German law would compel social media companies to shoot first and dont ask questions later in relation to anything thats reported to them. He also believes it would move Europe closer to a wholesale privatization of freedom of expression, with large internet companies deciding what they want the public the discourse to be, and how much restriction to impose to have legal certainty.
Maas defended the bill during parliamentary debate last month, describing it as a necessary measure to curb the spread of illegal speech. "The point of the proposed legislation is that statements that violate the law must be deleted," Maas said, according to Deutsche Welle. "These are not examples of freedom of speech. They're attacks on freedom of speech. The worst danger to freedom of speech is a situation where threats go unpunished.
Maas has been a particularly outspoken critic of Facebook, claiming that the social network should be treated as a media company, which would make it legally liable for hate speech, defamation, and other content published to its platform. The justice minister also criticized Facebook for failing to remove flagged hate speech in 2015, amid rising anti-migrant protests violence across Germany; prosecutors in Hamburg opened an investigation into Facebooks European head later that year for ignoring racist posts.
Facebook, Twitter, and Google agreed to remove hate speech from their platforms within 24 hours, under an agreement with the German government announced in December 2015. But a 2017 report commissioned by the Justice Ministry found that the companies were still failing to meet their obligations. Twitter removed just 1 percent of hate speech flagged by its users, the report said, while Facebook took down 39 percent. The companies struck a similar agreement with the EU in May 2016, and although Facebook has made progress in reviewing and removing illegal material, the European Commission said in a report last month that Twitter and YouTube are still failing to adhere to the voluntary accord.
Facebook and Google have also taken steps to combat fake news in Europe, amid concerns that misleading content could influence elections. Facebook began labeling fake news in Germany and France earlier this year, and it partnered with Correctiv, a Berlin-based nonprofit, to help fact-check dubious news stories.
Facebook pushed back against Germanys proposed law last month, saying in a statement that it provides an incentive to delete content that is not clearly illegal when social networks face such a disproportionate threat of fines.
It would have the effect of transferring responsibility for complex legal decisions from public authorities to private companies, the statement continues. And several legal experts have assessed the draft law as being against the German constitution and non-compliant with EU law.
When reached for comment, a Twitter spokesperson referred to a previous statement from Karen White, head of public policy in Europe, following the release of the European Commissions report. Over the past six months, we've introduced a host of new tools and features to improve Twitter for everyone, the statement reads, in part. Weve also improved the in-app reporting process for our users and we continue to review and iterate on our policies and their enforcement. Our work will never be done.
You cant just delete what these people are thinking.
Chan-jo Jun, an activist German lawyer who has filed several high-profile lawsuits against Facebook, says hes ambivalent about the draft law because it lacks what he sees as a crucial component. In a phone interview, Jun said the law should allow for users to appeal Facebooks decision to remove flagged content, and to force the company to hear the voice of the person whose post has been deleted. Free speech may be jeopardized without such a mechanism, he said, though he believes there is still a need for government oversight of social media.
If we think criminals should be prosecuted on the internet, then we have to make sure that German law applies on the internet, as well, Jun said, and that it is not only being ruled by community standards from Facebook.
Maas is looking to pass the bill before the Bundestags legislative period closes at the end of June the last chance to do so before national elections in September though it faces opposition from a broad range of politicians. Lawmakers from the far-left and far-right have strongly criticized the bill, as have organizations such as Reporters Without Borders. McNamee says that even if the law does pass, it likely will not hold up to legal challenges in Germany or Europe. In a non-binding ruling handed down last week, a German parliamentary body determined that the bill is illegal because it infringes on free speech and does not clearly define illegal content.
Maas has expressed support for Europe-wide laws on hate speech and fake news, though EU regulators have traditionally favored a more self-regulatory approach to policing online content. Yet new EU data protection rules slated to go into effect next May point to a more aggressive stance. Under the regulations, technology companies found to violate consumer privacy could face fines of up to 4 percent of their global turnover. (Facebook earned nearly $28 billion in global revenue in 2016.)
Up until now, one could argue that large tech companies have been able to, by and large, get away with saying, oh, its all technology and its all very difficult, says Joss Wright, a research fellow at the Oxford Internet Institute. Lately, however, European regulators have shown an increased willingness to take on tech companies directly, Wright adds.
In Germany, however, some activists worry that lawmakers who support the bill may be looking to score political points ahead of this years elections, while ignoring deeper societal issues that have allowed hate speech to propagate.
We fear that after this law comes to action, the whole debate is over for the politicians, and we are just right at the beginning, says Johannes Baldauf of the Amadeu Antonio Foundation, a Berlin-based NGO that tracks and combats hate speech and extremism. Baldauf, who leads a project tracking hate speech online, says there has to be some sort of legislation to curb illegal speech, though he believes it should be coupled with public awareness campaigns and public debates about what drives racism and xenophobia.
You cant just change the mind of the people by proposing a law, Baldauf says. And you cant just delete what these people are thinking.
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Kaepernick case isn’t about race but NFL censorship – Fort Worth Star Telegram (blog)
Posted: at 1:47 pm
Fort Worth Star Telegram (blog) | Kaepernick case isn't about race but NFL censorship Fort Worth Star Telegram (blog) In short, Kaep' is full of it. If a team had offered him a job with a seven or six-figure salary he would have played ball, even on the bench. He would have been dumb not to, and this is not a dumb man. Kaep's famous taking of a knee is the ultimate ... |
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Kaepernick case isn't about race but NFL censorship - Fort Worth Star Telegram (blog)
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Chinese Government Enforces Censorship by Targeting Local Broadcasters – The Merkle
Posted: at 1:47 pm
We all know the Chinese government is keeping a close eye on what content can be found on the Internet. China is not exactly known for freedom of speech or making information easily accessible. Various broadcasters and media platforms have been put on notice regarding broadcasts putting China or its government in a negative spotlight. This is another clear example of how censorship is enforced by oppressive governments.
It is understandable governments are not too happy when negative press gains mainstream traction. Reading about how a government official did X or Y wrong is not fun, even though such information deserved to be shared. Contrary to what the Chinese government may want to believe, negative information deserves to be known by the public as well. However, if it is up to government officials, that situation will come to a halt very soon.
More specifically, the Chinese government has warned local broadcasters regarding what they can and cannot share with the public. Any negative news regarding China or its government will be banned from now on. This appears to be a rather drastic decision, as this is a clear example of censorship. According to the State Administration of Press, Publication, Radio, Film, and Television, airing the dirty laundry violated local regulations.
It has to be said, this is quite an interesting turn of events. According to the government, all of the notified broadcasters share large amounts of programs with the public. However, a lot of this information doesnt comply with national rules. Moreover, there are seemingly more broadcasts regarding negative discussions about public affairs. This seems to indicate the local government isnt doing the job to the best of their abilities, yet no one is supposed to know about these things, it seems.
It is believed the agency will take measures: to shut down these programs airing the dirty laundry of China and its government. Considering the agency contacted both traditional and online broadcasters, it remains to be seen how this new rule will be executed. It is possible some broadcasters may effectively lose their license or suffer from major government repercussions, including fees and potentially even jail time.
It is not the first time we see such drastic actions taken by the Chinese government regarding censorship and freedom of speech. The country ranked in the bottom 5 countries on the 2017 World Press Freedom Index. It is evident freedom of speech and China will never be two peas in a pod, and one can only expect harsh measures like this to become even more common in the future. In fact, the government has recently been granted more control over the Internet and broadcasts in May of this year.
Interestingly enough, it looks as if some broadcasters are taking this new guideline to heart. Both Weibo and Acfun have made a post on their official Weibo accounts to state how they will enforce stricter content management. For Chinese companies, complying with new regulations is a top priority. No one wants to lose a license or face severe punishment for disregarding the rules. Moreover, Weibo will only allow users to broadcast if they have the proper government license to do so.
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Fighting censorship online: ‘It’s an ongoing race’ – Deutsche Welle
Posted: at 1:47 pm
DW: Mr. Baumhauer, according to the Freedom on the Net Report 2016, internet freedom has declined globally for six consecutive years. Users in China, Syria and Iran are among the most affected. The report also states that governments are increasingly censoring social networks and messaging apps like WhatsApp and Telegram. How does this affect strategies to hold online censorship in check?
The basic concept hasn't changed. Millions of people are affected by online censorship, it happens across the globe, it affects social media as well,and it's nothing new to DW. We know exactly that there are governments out there who don't want us to get into the country to make sure that our content reaches the people who live there. Depending on how the internet is set up technically in a certain country, it can be very easy to block websites. However, in some societies, for instance in Iran, the young generation is very capable when it comes to bypassing censorship - that also goes for messaging apps. We at DW won't accept censorship, and wherever it happens, we'll try to find a way around that. Bypass Censorship is just another approach.
The website provides download links and guides for a number of tools that help you go online without being tracked or get access to blocked content. How exactly does that work?
Some users at some point might have tried to watch a movie that was released in another country, for instance in the US, but not yet in their own country. They might have used some kind of VPN (virtual private network) software. These tools make it look like they're an American user, that way they get access to US servers. The tools we recommend on the website use a similar technology. After downloading them, they help users connect to various servers, and thus offer unrestricted internet access to them. For example, we use PSIPHON for our Farsi and Amharic services. Both Iran and Ethiopia are pretty good at censoring.
Some of the tools on the website, for instance TOR, are quite well-known, at least to people who know a thing or two about encryption. Does this mean the website is aimed at users who aren't familiar with these topics?
DW's Guido Baumhauer hopes that DW's knowledge of combating censorship can help internet users worldwide
Most of the tools have been out there for a while;none of them are brand new. In countries where censorship is a daily routine, let's say Iran or China, we find a lot of internet-savvy users who know what they are doing. But other users elsewhere might want to get access and feel a little helpless to begin with. We want to show them what possibilities they have.
Additionally, the website always provides download links for the newest versions of the tools. The moment the censors realize how the technology works, they start blocking the servers. The tool basically adapts to the censorship and tries to keep the road to free internet access open. It's an ongoing race and it will not stop until one side backs down - and that will definitely not be us. We will do everything we can to help people get access to information, because we believe freedom of speech is the highest value for people. Even if we only reach a few people through the website, it will be worth it.
But aren't you worried that the whole website might be blocked once word gets out?
That's definitely something that's going to happen, and we have to find ways for users to access the information on the website through other means. When content on the DW website gets blocked, for instance in Iran or China, we find ways around that and we'll do the same with Bypass Censorship. For example, we offer users to email the tools to them. That might sound stupid and very simple, but it works.
Experts say that tens of thousands of internet police are employed to implement China's "Great Firewall"
Bypass Censorship sounds like a project that could have been founded by activists or a hacker group. Why are leading international broadcasters getting involved?
If we're talking about providing free access to censored content that people should be able to see in order to know what is happening in their country and around them - which does not include promoting things that are lawless -I think we have the same mindset.
We have great people who know ways around censorship and we want to share this knowledge. In that respect, I think there is no difference between people who call themselves activists and broadcasters like DW.
Bypass Censorship is co-sponsored by Deutsche Welle, the BBC, the Broadcasting Board of Governors (BBG), France Mdias Monde (FMM) and the Open Technology Fund. Guido Baumhauer is DW's Managing Director of Distribution, Marketing and Technology.
Thisinterview was conducted by Helena Kaschel.
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GOP health care bill won’t be any better than ObamaCare, says Dr. Ron Paul – Fox Business
Posted: at 1:46 pm
Former presidential candidate Dr. Ron Paul (R-Texas) on Thursday expressed why he disapproves of the new GOP health care bill.
I dont expect it to be better because philosophically there is no difference because theres too many mandates, even on insurance companies. They have all these benefits, but then they holler and scream when they have to cover things. Republicans unfortunately havent done much better than the Democrats, he told FOX Business Liz McDonald.
Paul agrees with his son, Sen. Rand Pauls (R-KY) decision to stand against the GOP health care bill.
Hes (Rand Paul) on the right trackI know the points that Ive heard him sayget away from the benefits to the big corporations, in particular the insurance companies, yes he is right about that, he said.
The former presidential candidate believes that private insurance companies should compete with one another to lower monthly premiums.
The big problem is the more important services, the less the government should be involved, but medicine is one of the most important services some people will say. Thats where we have the most government interference, which does nothing more than boost up the cost, makes it complicated, he said.
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Alex Jones does NOT represent libertarians – Conservative Review
Posted: at 1:46 pm
Conservative Review | Alex Jones does NOT represent libertarians Conservative Review Megyn Kelly made headlines this week for her interview with controversial broadcaster Alex Jones, a self-described libertarian. For someone like me, this is distressing for a number of reasons. First, there's just the shameless appeal to sensationalism ... |
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Alex Jones does NOT represent libertarians - Conservative Review
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Hitting cardiovascular health targets can help elderly live longer … – KFGO
Posted: at 1:46 pm
Friday, June 23, 2017 4:23 p.m. CDT
By Will Boggs MD
(Reuters Health) - Meeting some or all of the American Heart Associations seven ideal cardiovascular health goals is associated with longer life and fewer heart attacks and strokes, no matter your age.
In fact, in a recent group of elderly patients, the benefit of an ideal cardiovascular health in reducing mortality and vascular events was comparable to what is observed in younger populations, Dr. Bamba Gaye from University Paris Descartes in France told Reuters Health by email. This is a very good news, which suggests that it is never too late to prevent the development of risk factors for cardiovascular disease (CVD).
Gaye and colleagues analyzed whether achieving some or all of the American Heart Association (AHA) seven ideal goals Lifes Simple 7 - would affect peoples risk of dying or having a stroke or heart attack during a specific study period.
The seven goals include:
-Keep body mass index (BMI) - a ratio of weight to height - lower than the overweight cutoff;
-Never start smoking, or have stopped at least 12 months ago;
-For at least 75 minutes a week, perform vigorous activity, or perform moderate physical activity at least 150 minutes a week;
-Follow a healthy diet that includes vegetables and fresh fruit daily, fish twice or more a week, and less than 450 calories a week from sugar;
-Keep blood pressure below 120/80 without medication;
-Maintain a normal cholesterol level without medication;
-Maintain a normal blood sugar without medication.
Out of the 7371 study participants, whose average age was 74, only one individual had met all seven goals. Only 5% of participants met at least five goals, researchers reported in the Journal of the American College of Cardiology.
For all goals except physical activity and total cholesterol, women were more likely than men to be at ideal levels.
The research team tracked the study subjects to monitor their health; half of the participants were tracked more than nine years.
Compared to people who meet no more than two of the goals, in those who met three or four the risk of death during the study was reduced by 16 percent, and meeting five to seven goals cut the risk by 29 percent.
In fact, the risk of death fell by 10 percent for each additional goal at the ideal level.
Similarly, the risk of coronary heart disease and stroke fell by 22 percent for each additional goal at the ideal level.
The ideal goal would be to have no risk factors for cardiovascular disease at all, Gaye said. However, our study also shows a graded benefit on outcome according to the number of risk factors at the optimal level. Hence, a perhaps more realistic approach would be to advise older subjects to have at least one risk factor at an optimal level, and to progressively gain more risk factors at optimal level.
We would like emphasize that (good) health in general and cardiovascular health in particular is the cornerstone of (good) life and we all need to take care of it over the life course, Gaye concluded. The good news is that it is never too late to optimize our own health in elderhood.
The goal of successful aging is not immortality, but limiting time spent with illness and disability, writes Dr. Karen P. Alexander from Duke University School of Medicine, Durham, North Carolina in an editorial published with the study.
This study, she continued, reminds us that risk factor and lifestyle modifications have no expiration date and continue to yield benefits for a healthy old age, well beyond age 70.
Older adults should focus not so much on the perfect attainment of Lifes Simple 7, but on the process of working to achieve these goals, she concludes.
Dr. Dana E. King from West Virginia University Medicine, Morgantown, West Virginia, who has studied elderly health extensively, told Reuters Health by email, "It is never too late to start or improve your healthy lifestyle habits. Elderly people who adopt healthier diets, get active, and quit smoking, actually benefit sooner and to a greater degree than young people.
SOURCE: http://bit.ly/2sOWXS0 and http://bit.ly/2s51MCd Journal of the American College of Cardiology, online June 19, 2017.
(This version of the story was refiled to correct typo in paragraph four, bullet point 2)
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Hitting cardiovascular health targets can help elderly live longer ... - KFGO
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Trees, Science and the Goodness of Green Space – Truth-Out
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The connection between trees, human health and well-being dates back millennia. The ancient Celts worshiped in sacred groves, believing the trees would protect them from physical and spiritual harm. In Hebrew and Christian scriptures a tree of life in the Garden of Eden imparted immortality. Potted conifers helped to cleanse the air inside tuberculosis sanatoriums of nineteenth century Europe.
In recent years, scientists studying urban forests have turned up links between exposure to green space and health benefits, including fewer deaths from heart disease and respiratory diseases, fewer hospitalizations, better infant birth weights and even less crime.
"We've had this intuitive understanding that nature is good for us. Now we're backing it up on an empirical level," said Geoffrey Donovan, a resource economist with the U.S. Forest Service Pacific Northwest Research Station in Oregon.
Donovan and others are digging into the underlying science to understand the relationship between nature and health, a step they say will help guide the design of healthier cities and suburbs.
"We've had this intuitive understanding that nature is good for us. Now we're backing it up on an empirical level."-Geoffrey Donovan, US Forest ServiceEarly indications of health benefits
In 1984, University of Delaware researcher Roger Ulrich made the observation that gall bladder surgery patients stayed in the hospital for less time and took fewer painkillers when they could see trees out their hospital window than when their window faced a brick wall.
Ulrich's studywas small -- just 46 patients -- and raised more questions than it answered. Yet it suggested for the first time scientifically that our perception of nature could potentially influence health outcomes.
That same year, American clinical psychologist Craig Brod coined the term "technostress" to describe the increasingly artificial elements of our built environment that appeared to be raising stress levels. Chronic stress can weaken the immune system. Some experts hypothesized that this kind of constant stress -- exacerbated by the urban environment -- was making people sick.
In Japan, Yoshifumi Miyazaki wondered whether the antidote could be as simple as a long walk in the woods. Miyazaki, a physiological anthropologist at Chiba University, is widely regarded in Japan as the father of forest therapy -- a preventive medicine approach aimed at preventing disease by exposing people to nature.
Over the last three decades, Miyazaki has led more than 60 studies investigating the physiological effects of being in a forested environment. His team has taken measurements including blood pressure readings and changes in heart rate. They've tested saliva samples for cortisol, a hormonal marker of stress. Overwhelmingly, they've found that when people spend time in a forest, their bodies act less stressed out.
Miyazaki hypothesizesthat exposure to natural stimuli -- the sound of a woodpecker drumming away on a tree trunk or the smell of damp pine needles, for instance -- promotes physiological relaxation. He's shown it may help to lower blood pressure, stress hormone levels, sympathetic nervous system activity (think fight-or-flight response) and relieve depression and anxiety.
But how much time in the forest is enough? A group of Stanford researchers in 2015 showed that just a 50-minute walk in a park or forest could decrease anxiety and rumination (a psychology term that basically means dwelling on the negative thoughts caused by upsetting situations) compared to a50-minute walkthrough an urban environment.
A New Environmental Exposure -- Greenness
What do those nature exposures mean when they add up over a lifetime?
Previous research suggested that neighborhood vegetation might reduce obesity, promote physical activity, and improve mental health and heart health. Yet most of these studies looked only at one point in time -- making it tricky to tease out whether living on a green block actually made people healthier or whether healthier people just chose to live in greener neighborhoods.
Adding to the problem, urban dwellers often pay a premium for access to green space. If wealthier people are more likely to live in greener areas and wealthier people also are more likely to have better health outcomes, maybe it's their wealth -- and not exposure to nature -- that's making them healthier.
James and his colleagues at Harvard set out to examine the association between greenness and mortality in a large, ongoing study of nurses living in mostly urban areas around the country. In gathering data repeatedly on the nurses over time (and the terminal nature of the chosen endpoint -- death) it was more likely that any association between greenness and mortality was actually due to the greenness and not some other factor.
And the fact that all study participants shared the same occupation -- nursing -- made it less likely that socioeconomics would confound their results.
In a2016 study, the researchers reported that nurses with high levels of greenness surrounding their homes over the course of the eight-year study were about 12 percent less likely to die during that period than nurses living in the least green areas. The associations were strongest for respiratory, cancer, and kidney disease-related deaths.
They found that the association between greenness and mortality appeared to be explained by women living in greener neighborhoods experiencing less depression, higher levels of social engagement, more physical activity and lower exposures to air pollutants than their peers living in less green neighborhoods.
A Natural Experiment
"If nature can make us feel better in the general sense, then we should be able to see measurable differences in human health," said Donovan, who studies the social and health benefits provided by urban trees.
Under normal circumstances, he said, studying how large-scale changes in foliage over time impact the health of communities would take ages. It could take a generation or more before newly planted trees form a mature urban tree canopy.
Yet nature set up the experimental conditions Donovan needed to study the relationship between trees and health outcomes. The loss of more than 100 million ash trees over the last decade and a half has drastically changed the landscape in many U.S. cities -- making them a perfect laboratory to study the relationship between tree cover and health.
"Exposure to vegetation can be very restorative, but design does matter."-William Sullivan, University of Illinois at Urbana-ChampaignThe culprit? A shiny green beetle named the emerald ash borer. The ash borer, native to Asia, first turned up in Detroit in 2002. It's been spreading across the Northeastern U.S. since, leaving behind a trail of dead ash trees.
Using the presence of the ash borer as an indicator for tree loss, Donovan and his colleagues showed an increase in deaths associated with the presence of the beetle. In counties across a 15-state area, Donovan attributed about 15,000 additional heart disease-related deaths and about 6,000 respiratory disease-related deaths to a loss of trees caused by the emerald ash borer. They publishedtheir results in 2013.
"The magnitude of the effect was really eye-opening," Donovan said.
New Tools to Quantify Effects
Studies such as Donavan's natural experiment with the emerald ash borer give experts confidence that nature really is affecting health -- that researchers haven't just stumbled upon a giant set of coincidences.
Yet more science is needed "to tell us the conditions under which nature will and will not improve health, and how to use nature to improve health," said Ming Kuo, director of the Landscape and Human Health Laboratory at the University of Illinois at Urbana-Champaign.
"Exposure to vegetation can be very restorative, but design does matter," said William Sullivan, a landscape architect also at the University of Illinois at Urbana-Champaign. Hacking your way through an overgrown lot, for instance, may not have the same calming or restorative effect as a casual stroll through a grove of trees or an urban park.
As landscape architects move toward creating more ecologically healthy landscapes that foster ecosystem services -- for instance flood mitigation or temperature regulation -- it's important to understand the human health implications too, Sullivan said. For instance, are you creating a reservoir for mosquitoes, ticks or other insects that could be carrying disease?
"We need information on how exposure to different forms of green space impact health, how much exposure people need, and what kind of designs -- arrangements of plants, types of plants -- are healthy for the environment and for people," he said.
"Planting trees can literally save the lives of people."-Satoshi Hirabayashi, The Davey Tree Expert Company, US Forest ServiceResearchers now are developing tools that may soon answer some of these questions. Satoshi Hirabayashi, an environmental engineer at The Davey Tree Expert Company and the US Forest Service in Syracuse, New York, studies how much air pollution is removed by different types of trees and then estimates how those reductions in air pollution benefit human health. Previous studies suggest as many as 135,000 US deaths annually can be attributed to ground level ozone and fine particulate matter. Trees absorb some of those airborne particles by trapping them on their leaves and bark while gaseous pollutants are taken in through the leaf stomata.
Hirabayashi and colleagues are developing a national database that will allow users to quantify the air quality and related human health benefits associated with any forested area anywhere in the US. "We will be able to show people what kind of air pollution removal is going on in their own backyard," he said.
So far, they've shown that tree type matters and that urban trees give more bang for the buck when it comes to health benefits. Evergreens do a better job of removing pollutants year-round than deciduous trees, which drop their leaves in the fall, Hirabayashi found. And while rural areas experience more total air pollution removal from trees than urban areas (due to more tree cover in rural areas), the effects of that air pollution removal on human health appear greatest in urban areas where the most people are concentrated.
Urban forest managers and city planners around the country have begun using this technology to better understand the health savings associated with city trees on both a community and backyard level using tools such as i-Tree Eco and i-Tree Design, according to Hirabayashi. These programs can estimate air quality and associated human health benefits anywhere in the US.
"Planting trees can literally save the lives of people," he said.
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Trees, Science and the Goodness of Green Space - Truth-Out
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